Arch Hand Microsurg.  2024 Mar;29(1):24-33. 10.12790/ahm.23.0052.

Contributing factors to hand flexor tendon rerupture

• Koh SH
• Kim YW
• Kim JS
• Lee DC
• Roh SY
• Lee KJ

• KMID: 2553168
• DOI: http://doi.org/10.12790/ahm.23.0052

Abstract

Purpose
This retrospective study aimed to identify factors influencing hand flexor tendon rerupture and to develop preventive strategies for patients who have undergone hand flexor tendon repair.
Methods
In total, 287 patients who underwent hand flexor tendon repair between January 2011 and June 2022 were included. Patients with thumb injuries, amputations, bone injuries, extensor tendon injuries, and those with less than 3 months of follow-up were excluded. Patients were divided into rerupture and non-rerupture groups. Events leading to ruptures were also investigated. The two groups were compared according to sex, age, occupation, smoking status, history of diabetes mellitus, injury characteristics, core suture method, and timing of the rehabilitation course.
Results
Of the 287 patients, 19 experienced rerupture (6.6%). The mean time to rerupture was 25.3 days. Reruptures occurred due to unknown causes in nine cases (47.4%), noncompliance with medical recommendations in seven cases (36.8%), and trauma in three cases (15.8%). Among the investigated factors, little finger injury and concurrent flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) ruptures were significantly associated with rerupture. Little difference was noted in the core suture methods and timing of the rehabilitation course between the two groups.
Conclusion
To minimize the risk of rerupture, patients should strictly adhere to medical recommendations and avoid any activities that could cause trauma for at least 1 month after surgery, which is the critical period for tendon remodeling. Patients with little finger injuries as well as concurrent FDS and FDP ruptures require special attention and careful monitoring.

Keyword

Hand injuries; Tendon injuries; Rupture; Reoperation; Risk factors

Figure

• 

  Fig. 1. A 16-year-old girl presented with a complete rupture of the flexor digitorum profundus (FDP) tendon due to a cutter knife injury. (A, B) Intraoperative images from the initial repair of the FDP tendon. (C) A 28-day follow-up image showing flexion failure of the distal interphalangeal joint after throwing a book. (D, E) Intraoperative images from the re-repair of the FDP tendon. (F) An 8-month follow-up image after reoperation showing a full range of active flexion motion.

• 

  Fig. 2. A 62-year-old man presented with a complete rupture of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendon due to an injury from broken glass. (A, B) Intraoperative images from the initial repair of the FDS and FDP tendons. (C) A 36-day follow-up image showing a limited range of active flexion motion after grabbing a cellphone. (D, E) Intraoperative images from the re-repair of the FDP tendon, with the intact FDS tendon. (F) A 10-month follow-up image after reoperation showing improvement in the range of active flexion motion.

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  Fig. 3. Distribution of rerupture days for each patient by cause.

Reference

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